Audit of Clinical Indications for Primary Cesarean Section in a Tertiary Care Hospital

Background: Cesarean section (CS) rates are rising globally, with primary cesarean deliveries contributing substantially to maternal and neonatal morbidity. Identifying the leading indications and evaluating labor management practices is essential to improving obstetric care and reducing unnecessary procedures. Objective: To assess the indications for primary cesarean section in a tertiary care hospital. Study Design: Clinical audit. Setting: Department of Obstetrics and Gynecology, Khyber Teaching Hospital, Pakistan. Duration of Study: January 2025 to June 2025. Methods: A total of 150 cases of primary cesarean delivery were prospectively enrolled. Data were collected using standardized case record forms documenting demographic characteristics, labor progression parameters, fetal monitoring methods, surgical indications, and maternal and neonatal outcomes. Statistical analysis was performed using descriptive methods and comparative assessment of labor management practices. Results: Emergency cesarean sections accounted for 80.7% of cases. Fetal distress (41.3%) and VBAC (35.3%) were the most common indications, followed by breech presentation and failed induction. Incomplete partograph documentation was observed in 71.3% of cases, and fetal monitoring methods varied across patients. Maternal complications occurred in 12.0% of cases, while neonatal outcomes revealed 11.3% with low Apgar scores and 10.7% requiring NICU admission. Comparative analysis highlighted significant inconsistencies in the diagnosis of fetal distress and labor management approaches. Conclusion: Fetal distress and VBAC were the leading indications for primary cesarean delivery. The findings underscore the urgent need for standardized fetal monitoring protocols, consistent partograph utilization, and improved labor management strategies to optimize maternal and neonatal outcomes and reduce unnecessary cesarean sections.